Dear Alice,

I was on a two-week home stay in the countryside of Japan when a visitor came to the house. I don't think he was expected, but my home-stay mother greeted him like an old friend and fetched a plastic drawer-box from the kitchen, which seemed to contain packaged medicines. While they chatted over tea, he went through the drawer counting packages and checking something on each package. He replaced certain products and seemed to recommend others, some of which went into the box. In the end, my home-stay mother paid what seemed to be a very small amount of money considering the amount of product left behind. They parted warmly and the box went back into the kitchen. She confirmed the products are medicine but otherwise couldn't explain what the heck was going on. Can you?

Gary K, Hong Kong

Dear Gary,

You witnessed a sales call for okigusuri, a uniquely Japanese method of marketing medicine, and one that has a history of well over 300 years. Here's how it works: A variety of medicines are brought to your home and entrusted to you without any deposit or advance payment. You are given a free case in which to store them. There's no obligation to buy anything but the medicines are there if you need them. And should the need arise, you may use anything from the box on the understanding that the next time the sales representative comes around, you'll pay for only what you've actually used.

In Japanese, this way of selling is called senyō kōri (use first, pay later). Today, it is most strongly associated with medicine manufacturers in Toyama Prefecture, which together supply more than half of all okigusuri. This part of the country, located on the Japan Sea coast in the central part of the country, has had a high concentration of medicine makers ever since the Edo Period (1603-1867), when the area was called Etchu province. By the early 18th century, medicines from Etchu were sold throughout Japan, no small feat given the distances and strict restrictions at the time on travel and trade.

The story goes that in 1690 the feudal head of the province, Masatoshi Maeda (1649-1706), was on a formal visit to Edo Castle when another lord fell seriously ill with a stomach complaint. Maeda immediately offered a remedy from his region, which he always carried with him, and it almost instantly relieved the man's suffering. Impressed, the many lordly witnesses to this speedy recovery spoke to Maeda afterwards, asking that the medicine be made available in their own domains.

Thanks to this official support, it became possible for medicine sellers from Etchu to enter other domains to peddle their products. The industry cooperated on distribution, dividing the country into 18 to 22 territories and assigning routes. Salesmen typically made two trips a year, carrying products in a set of nesting woven baskets tied to their back with a large cloth. To gain consumers' trust for an unfamiliar medicine, they left their products with no advance payment and no obligation to use it. People often assume that the Etchu medicine manufacturers pioneered the "use first, pay later" method of sales, but recent research has confirmed that it was used even earlier for a variety of products, including cooking pots, hoes and mosquito nets.

To find out how the okigusuri industry works today, I set up an appointment with Masao Inoya, immediate past chairman of the Tokyo-to Iyakuhin Haichi Kyokai (Tokyo Metropolitan Medicine Placement Association) and an okigusuri salesman with more than 60 years in the business. Inoya says he places medicines in both homes and offices, and generally visits each client two or three times a year to replenish supplies and collect payment for product used.

When I asked what the salesman you observed was looking for on the packages, Inoya said he was checking the expiration date, because unopened but out-of-date product is removed and replaced at no charge. The average okigusuri box, which is called a haichi-bako or azuke-bako, he said, is kept stocked with 15 to 20 products worth something in the range of ¥7,000 to ¥10,000. Inoya said his rate of collection is very nearly 100 percent, and the industry has few problems with customers disappearing with the goods or refusing to pay.

The actual selection of products varies by distributor and customer preference, but the typical okigusuri box will contain pain relievers, cold medicine, throat lozenges, stomach remedies and bottled health tonics. It usually also includes first-aid supplies such as bandages, disinfectant and shippu, which are packaged hot or cold compresses that may be treated with analgesics or anti-inflammatory drugs. Inoya told me his particular area of strength is health-promoting medicines that people use even when they aren't experiencing any particular symptoms.

"I'm not selling medicine; I'm selling health," he asserted. "So I have to be healthy myself." And to show me just how healthy he is, Inoya, who is 77, got down and did the splits, sitting with his legs flat to the floor and straight out to the sides. That alone would have impressed me, but then he bent forward and touched his head to floor. Such health and flexibility must serve him in good stead, because he now has to travel a much wider area in order to maintain sales.

"Unfortunately, sales of okigusuri are down," Inoya explained. "When I started in the business, someone was home during the day in most households. And there were fewer stores in neighborhoods. But now more women work outside of the home, and there's a drugstore on every corner. People just have more options for buying medicine."

Interestingly, the "use first, pay later" system has been introduced in developing countries to improve access to health care. With support from the Nippon Foundation, programs in Mongolia, Thailand, Myanmar and Vietnam provide rural families with health education and cases of locally manufactured traditional medicines. The participating families can use the medicine if they need it, and pay only for what they use.

For more on this topic, including a video so you can watch an okigusuri sales call for yourself, as well as links to information on okigusuri outside of Japan, please visit my blog at alicegordenker.wordpress.com. Puzzled by something you've seen? Tell me about it: [email protected] or Alice Gordenker, A&E Dept., The Japan Times, 4-5-4, Shibaura 4-chome, Minato-ku, Tokyo 108-8071.